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Evolent Health Director, Risk Adjustment and Quality Operations in United States

Director, RASQ Operations

The Director of Operations will be on the Risk Adjustment, Stars, Quality team. You’ll be working with teams within RASQ and other departments within Evolent Health Services to deliver Risk Adjustment and Quality services and technology to internal and external stakeholders.

Responsibilities

  • Multi-market planning & delivery

  • Create multi-market implementation plans to deliver accurate risk & quality suspects and reports/analytics

  • Identify & sequence work

  • Identify and resolve & escalating risks & issues

  • Collaborate with inter and intra departmental functional leaders

  • Ensure timely & seamless delivery

  • Serve as dyad with multi-market strategy lead to ensure RASQ is prepared to meet client needs (suspects, reports, etc)

  • Propose and usually implement process improvements to enhance partner success or team scalability

  • Physician Experience Champion

  • Collaborate with RA/Quality Implementation team to design and execute on a provider experience framework for clinical implementations.

  • Structure a provider RA & Quality implementation/roll-out plan (when we launch a new client, what’s our first provider touch point? Who do we walk to? What do we cover? What do we ask of them? What materials do we need? What comes next? Would be a well thought out plan, but flexes by client)

  • Request and prioritize provider education collateral: medical coding, how to interpret reports, how to use tech platform

  • Give UX feedback to ensure reports & platform resonate with providers

  • Collaborate with the strategy team on provider incentive design and implementation.

  • Serve as RASQ Operations liaison to PNMs and PHMs re: reports and platforms

  • EMRi Lead

  • Work with clients to assess EMRi options for their EMR landscape

  • Lead efforts to implement EMRi solutions

  • Routinely survey the market for EMRi solutions that will improve partner performance

  • Own relationship with EMRi vendors

  • Compose functional specification for any EVH-insourced EMRi endeavors

  • Product Functional Lead

  • Ensure seamless, accurate & timely population of RA & Quality suspects via Identifi/ASTRID platform

  • Serve as provider & practice advocate to platform developers, creating an experience pleasing to end users

  • Research and work with product teams to resolve platform issues

  • Leads team:

  • Data entry specialist(s) (may be temp or off-shore resource(s))

  • Operations Specialist

  • Opportunity for additional staff over time

Qualifications

  • Bachelor’s degree in Public Health, Business, Healthcare Administration, Marketing, Communications or related field

  • 5-8 years of experience in analyzing risk adjustment and quality performance data

  • 5 years of experience in progressive leadership experience in Managed Care, Payer/Provider/Health Plan and/or Health system

  • Experience with payers and billing including knowledge of ICD-10 coding and HEDIS guidelines

  • Experience in provider-facing practice-management software platforms, including risk adjustment and quality reporting

  • 3-5 years as a people manager

  • Advanced Microsoft Office skills (e.g., Excel formulas and pivot tables)

  • World-class listening and communication skills

Finishing Touches (Preferred)

  • Experience using various prominent EMRs including understanding of backend data exchanges

  • CRC or similar medical coding certifications

  • Experience in primary care practices

  • SAS or SQL coding skills or a willingness to learn

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

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